‘Absurdly common’: Physicians need to be more proactive about iron deficiency

Despite their high prevalence and the fact that they are entirely correctable, iron deficiency and iron-deficiency anemia have not been prioritized in clinical settings and are not widely considered important markers of hematological health, according to an Ontario hematologist. That’s because they have been structurally sanctioned and normalized, said Dr. Michelle Sholzberg in a presentation at the Black Physicians’ Association of Ontario’s annual symposium in late February.Laboratory results flag abnormal iron levels only when they are below a threshold that Dr. Sholzberg considers “inappropriately low.”“It’s like flagging something when the wheels are already off the car, as opposed to saying, ‘Oh it’s low, you should think of acting,’” she told the Medical Post.In assessing a person’s iron levels, labs test for levels of both hemoglobin and ferritin, a protein that stores iron and is “the best indicator of somebody’s total body iron status,” Dr. Sholzberg said. Evidence shows that a normal ferritin level is 50 μg/L, while 30 μg/L and below is generally accepted as the threshold to mark iron-deficiency in adults. Fifty micrograms per litre is considered normal because it's the level at which gastrointestinal absorption of iron returns to baseline and biochemical markers of iron deficiency normalize, Dr. Sholzberg explained.Yet currently, the level of ferritin in a person is only flagged when it’s below 12 or 15 μg/L.However, Dr. Sholzberg, among others, is working for the threshold to better reflect available evidence: the “ferritin lower limit of normal” is moving to less than 30 μg/L in adults and less than 20 μg/L in children, according to Dr. Sholzberg. The change is set to happen at the largest laboratories in Canada in the next couple of months.“I didn't do this work alone. . . . This is done over multiple years with many, many, many stakeholders and lots of people advocating for this important change,” she said. “The idea is for us to make this first step forward, in a really structural way, for the province and for the country, so that other geographical jurisdictions can follow.”Inextricable link between hematological conditionsIron deficiency and iron-deficiency anemia were just two of the several “inexplicably linked themes” for women of reproductive age that Dr. Sholzberg presented on. The others were heavy menstrual bleeding and postpartum hemorrhage. “The more you bleed, the more iron deficient and anemic you become. And the more anemic you are, the more you bleed. And the more you bleed, the more likely you are to miss school and work. And the more vulnerable you are, the less likely you are to receive care and achieve success. And the more unaddressed your heavy menstrual bleeding is, the more anemic you are entering your pregnancy and the more likely you are to have a postpartum hemorrhage and die,” she said during her presentation.Iron deficiency is “absurdly common,” noted Dr. Sholzberg in her presentation, affecting women disproportionately, to the tune of 30%-to-50% of women globally. Indeed, it is the leading cause of years lived with disability in women. Symptoms include fatigue, irritability, restless legs and decreased cognitive function. It can also cause mood disorders.The global prevalence of iron-deficiency anemia is at least 33% around the globe, affecting about 2 billion people, annually. Every year, approximately 14 million women experience postpartum hemmorrhage, accounting for 70,000 maternal deaths. It is the number-one cause of maternal death, and Black women are about three-times more likely than white women to die of postpartum hemorrhage in the U.S.

‘Absurdly common’: Physicians need to be more proactive about iron deficiency

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